We live in a society where we are taught that we can overcome almost any stress, pain or obstacle. People are therefore often unwilling to experience discomfort and will be quick to take medication to suppress it. When this is coupled with a lack of doctors’ resources and increasingly lax prescription rules[2], we see a growing crisis of the overprescription of drugs.

It is increasingly apparent that the overprescription of these medications has been a significant driver of a devastating health problem in the United States.[3]

Multiple factors are in play in this crisis, which has led to a lack of education about the dangers of prescription drug use and the need for patients to require further treatment and detoxification.

“Misuse of prescription opioids and heroin affects more than 2 million Americans and an estimated 15 million people worldwide each year.” – US National Library of Medicine.[1]

Common Overprescriptions

Although the overprescription of any drug is potentially dangerous, the most commonly abused are opioids, benzodiazepines, and stimulant drugs used to treat Attention Deficit Disorder.

Opioids are usually used as a short-term measure post-surgery or for acute pain[4]. Although they can relieve those living with chronic pain, to date, there has been no evidence to support any proposed benefits of long-term use. Opioids are highly addictive, and tolerance for the drugs builds quickly, making it one of the most dangerous families of prescription drugs. The most commonly prescribed opioids are Vicodin and Oxycontin. When a user builds tolerance, the drugs’ effects lessen and they need to take an increased dose to achieve the same effects, which in turn creates a dependence. Because opioids slow breathing and heart rate, an overdose can be fatal.

Another of the most controversial prescription drug families is benzodiazepines; most commonly, Xanax and Valium. These tranquilizers, often prescribed for anxiety, are highly addictive. [5] College students often misuse these drugs when they find themselves in a climate which normalizes their use.[6] The tranquil state these drugs can induce makes it easy to fall into regular use and a negative pattern of behavior.

College and high school students also misuse Adderall, Ritalin or any other of the stimulants used to treat ADHD or ADD. They tend to  use the drugs to stay up late into the night studying or to hyper focus in a class or for an exam.

Why is it Happening?

The cause of the problem is multi-faceted and difficult to determine. Because each patient’s needs are complex and unique, medications, dosage and their affects vary from person to person. An overprescription for one patient could be an under prescription for another and be just the right amount for someone else.

It would be easy to  blame the doctors who write the prescriptions. However, this is not a helpful response, nor is it wholly accurate. Doctors are working under extreme constraints in time, budget and resources.

The length of time that a doctor has in a patient consultation does not allow for him or her to gauge the patients’ needs fully, to understand their and their family’s medical histories, and ascertain any previous addictions or vulnerabilities to addiction.

Doctors also have incentives to prescribe certain drugs. For example, opioids are often prescribed in an emergency room setting. This makes sense as the patient is likely to be in severe pain and the opioid will target that quickly and efficiently. It is also often easier to prescribe a large bottle instead of dividing up the medication for just a few days. In this case, a patient will leave feeling well cared for and reassured that they can keep the discomfort at bay. As there are not enough resources in our healthcare system for aftercare, follow up and medication advice, the patient is likely to continue taking the prescription beyond the point at which it is of benefit.

Doctors are also incentivized by large pharmaceutical brands to prescribe their drug over others. Physicians can even be rewarded with payments and gifts in exchange for prescribing a particular medication. By allowing this to happen in the industry, profit is being prioritized over patient care.

What Can we do About Overprescription?

The reasons behind our overprescription crisis are varied and complex. However, I have identified three core areas which need immediate attention:

  1. Further Training – Physicians do not receive the appropriate level of training in pharmacology. They are not taught how to manage habit-forming medications effectively, monitor repeat prescriptions, and manage pain while treating the patient’s symptoms. [7]
  2. Alternatives – There is a growing trend towards holistic, homeopathic and alternative medicines and therapies. Thankfully, this area has been growing in recent years as studies provide evidence-based findings on their success. Prescribing a lower level of pain medication[8] could also be helpful, especially for more minor surgeries or for short term discomfort. If the prescription of addictive substances can be avoided, then it should be at all costs.
  3. Medical Responsibility – Prescribing opioids and other potentially habit-forming drugs should only be done when the physician has a full understanding of the patient. If the right questions are not being asked, then it is up to the patient to ensure that the doctor has the appropriate information. Take the time to educate yourself on the risks  and the psychological and social factors that can lead to a misuse of substances.[9] These include mental health disorders, trauma, PTSD, childhood abuse, personality traits such as impulsivity and sensation seeking.  Certain health, lifestyle, economic and social factors also suggest a profile of an individual who is more likely to self-medicate.  By taking all of these factors into account, a patient will be able to notify the doctor of any risks before a course of medication is prescribed.
  4. Patient Education: It is an all-too-common story for my clients to have ended up using street pharmaceuticals or heroin via a prescribed opiate. Clients frequently tell me that they took opioids thinking they would make them feel better with no consequences. We are not passing on enough knowledge of how these drugs can be habit-forming and how this habit can escalate. We owe it to our nation to have honest and frank discussions about this and to disseminate judgment-free advice.

Overprescription is an escalating problem. Miseducation, lack of training, patient accountability and the financial influence of pharmaceutical brands are all contributing to the overprescription crisis. This is not only affecting the doctors and patients in the overprescription dynamic but also the wider community as prescription drugs gain popularity on the black-market and increase in terms of accessibility to the general population. Change starts with education.

For more information on treatment, contact Heather R. Hayes & Associates – call 800-219-0570 or email info@heatherhayes.com today.

 

 

 Sources

[1] “Opioid Addiction – Genetics Home Reference – NIH.” U.S. National Library of Medicine, National Institutes of Health, 2020, ghr.nlm.nih.gov/condition/opioid-addiction

[2] Wilford, Bonnie B., et al. “An Overview of Prescription Drug Misuse and Abuse: Defining the Problem and Seeking Solutions.” The Journal of Law, Medicine & Ethics, vol. 22, no. 3, Sept. 1994, pp. 197–203, doi:10.1111/j.1748-720X.1994.tb01295.x.

[3] Compton, Wilson M. et al. “Prescription Opioid Abuse: Problems And Responses”. Preventive Medicine, vol 80, 2015, pp. 5-9. Elsevier BV, doi:10.1016/j.ypmed.2015.04.003. Accessed 4 Nov 2020.

[4] Macintyre, P. E., et al. “Opioids, Ventilation and Acute Pain Management.” Anaesthesia and Intensive Care, vol. 39, no. 4, July 2011, pp. 545–558, doi:10.1177/0310057X1103900405.

[5] de las Cuevas, Carlos et al. “Benzodiazepines: More “Behavioural” Addiction Than Dependence”. Psychopharmacology, vol 167, no. 3, 2003, pp. 297-303. Springer Science And Business Media LLC, doi:10.1007/s00213-002-1376-8. Accessed 4 Nov 2020.

[6] McCabe, Sean Esteban. “Correlates of nonmedical use of prescription benzodiazepine anxiolytics: results from a national survey of U.S. college students.” Drug and alcohol dependence vol. 79,1 (2005): 53-62. doi:10.1016/j.drugalcdep.2004.12.006

[7] Schoen, Cathy et al. “A Survey Of Primary Care Physicians In Eleven Countries, 2009: Perspectives On Care, Costs, And Experiences”. Health Affairs, vol 28, no. Supplement 1, 2009, pp. w1171-w1183. Health Affairs (Project Hope), doi:10.1377/hlthaff.28.6.w1171. Accessed 4 Nov 2020.

[8] Grant, Daniel R. et al. “Are We Prescribing Our Patients Too Much Pain Medication?”. The Journal Of Bone And Joint Surgery, vol 98, no. 18, 2016, pp. 1555-1562. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.16.00101. Accessed 4 Nov 2020.

[9] Gorsuch, Richard L., and Mark C. Butler. “Initial Drug Abuse: A Review Of Predisposing Social Psychological Factors.”. Psychological Bulletin, vol 83, no. 1, 1976, pp. 120-137. American Psychological Association (APA), doi:10.1037/0033-2909.83.1.120. Accessed 4 Nov 2020.